Seriously, I’ve been wanting to write more often. Writing helps me, or it used to. Also, it’s not that I’m uninspired. A dozen ideas to write on float through my mind, but once I sit down to actually blog, it seems all pointless. Today I feel relatively well mood-wise, so I’m just forcing myself to write. I am choosing to write for Mama’s Losin’ It’s Writer’s Workshop on the prompt of seven things to do more often. There is also a prompt to write on seven things to do less often, but I couldn’t think of that many things to do less frequently.

1. Write. This I explained above already. Writing used to be a way of helping me process stuff and at the same time a way of distracting me from my depressive thoughts. Now already for nearly two years, I seem unable to write as often as I used to. Whether depressive symptoms are the cause or the effect, I do not know.

2. Move. Last week, I finally bought myself a Fitbit activity tracker. It’s a cool gadget, but so far, I’ve not been able to get moving nearly enough to meet the recommended targets. For example, I average about 3000 steps a day, while 10000 is recommended.

I don’t think my depressed mood is the reason I’m not moving. I just don’t think I can find the opportunity to. I mean, I shouldn’t go running up and down the stairs for fun, should I? And since I can’t leave the house without assistance, going for a walk is rather hard. The weather lately obviously hasn’t helped, as it’s freezing and feels even coldre. I hope that, once the temperature rises, I can get my support workers to take me on some walks again.

3. Meditate. I have two meditation apps on my iPhone but havent’used them in weeks. I really would like to practise mindfulness more.

4. Do sensory-friendly activities, like melting a wax melt or listening to soothing music.

5. Read. I don’t just mean books, but blogs too. I after all don’t seem to have the attention span to read a book most of the time, but I can usually read blog posts.

6. Show my love to my husband. This has been hard lately because of my depressed moods.

7. Focus on the positive. I really want to seek out emotionally positive experiences more. The above six practices will help me achieve this. If I can appreciate positive experiences for what they are, I’ll hopefully feel even better soon.

Of course, these seven things won’t magically make me feel happy, but they will help me move in that direction. Depressive symptoms and inactivity make each other worse, after all.

It’s already the second week of 2018 and I haven’t written about my goals or hopes or dreams for the year yet. Last year was a productive year, mostly because I finally moved out of the mental institution after 9 1/2 years. From there on, I’ve been attempting to move forward and live a healthier life in many different respects. Physically, I embarked on a weight loss, healthier eating and fitness journey. I was also referred to an occupational therapist for help with my mobility and fine motor impairments. For my mental health, I started dialectical behavior therapy.

I also started day activities once out of the institution. This is a huge accomplishment, as I could never handle the pressure of going to a day center for any prolonged amount of time. At first, I went to an industrial group, but I was later moved to a sensory-based group. This has been a very positive experience. I also started horseback riding in September and swimming with my husband in November. Lastly, I got an iPhone. All in all, I did a pretty godo job of ticking off the items of my 2017 bucket list.

It doesn’t mean I don’t still struggle. In 2017, I took two overdoses which required a night on the internal medicine ward. As I mentioned last Sunday, on Wednesday, I engaged in pretty bad self-injurious behavior at day activities. I’m still often very much stressed out.

On Writes Like a Girl, Nicole shared an interesting take on the cycle of life: she theorized that one year is for action and the next for maintenance. Her 2017, like mine, was totally about moving forward. She deliberately chooses 2018 to be a year for rest and calm. She will continue to move forward, but at a slower pace than she did in 2017. Same for me.

My word for 2018 is a word that fits in nicely with dialectical behavior therapy. The first skill we work on in DBT is mindfulness. Mindfulness is pretty much hyped up and I’m not too sure I fully understand it. Even so, I think it’s an important skill. Like Nicole, I need to do less and be more. My word for 2018, for this reason, is simply (or not so simply): be.

This doesn’t mean I don’t have goals for 2018. For example, I do still want to continue my healthy living and weight loss journey and set myself a new goal weight for the end of the year. However, I’m taking this slowly. After all, I’d rather lose the weight slowly and keep it off than lose it rapidly only to gain it all back.

Other than this, I don’t have any goals that require me to reach a certain end result. I mean, I’ve set myself a goal of keeping a jornal, but I’ve not set a requirement of how often or how much I need to write. I also really hope to blog more this year and I think I’m finally ready to ditch my mediocre Dutch blog and move my focus entirely back here.

Welcome to the letter M post in my #AtoZChallenge on mental health. We’re finally halfway through the challenge. It’s proving pretty hard for me. Particularly, I’m finding it hard to comment on others’ posts regulalry. Sorry about that. This letter was an easy one.

Medication

Medications are usually believed to be an essential part of treatment for severely mentally ill people. The most common psychiatric medications used are antipsychotics, antidepressants, mood stabilizers and benzodiazepines. I will discuss benzodiazepines separately.

Practically everyone on a long-term inpatient unit takes an antipsychotic. It seems every psychiatrist has their favorite medication of first chooice, though a large number of patients take clozapine. This is not the antipsychotic of first choice, since it can cause potentially fatal side effects, but many people on long-term units are treatment-resistant. Other well-known antipsychotics are aripiprazole (Abilify), risperidone (Risperdal), olanzapine (Zyprexa) and quetiapine (Seroquel).

Commonly-used antidepressants include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and citalopram (Celexa). These belong to the newer class of antidepressants, called SSRIs. Venlafaxine (Efexor) is an example of an even newer class, called SNRIs. It isn’t as commonly used though. (Efexor in partiuclar was heavily promoted by big pharma in like 2008 but it seems it’s not the wonder drug originally thought.) When people have treatment-resistant depression, they may get older antidepressants (tricyclics of MAOIs) or an antipsychotic (particularly Abilify) may be added. Mood stabilizers are primarily for people with bipolar disorder. Lithium is th most well-knwon mood stabilizer, but anticonvulsants (originally intended for people with epilepsy) are becoming more and more commonly used.

Mindfulness

Mindfulness is one of the recently hyped-up treatments for mental health problems. There are mindfulness workbooks for everything from depression to bulimia to obsessive-compulsive disorder. Mindfulness can be a great part of psychotherapy, but of course it isn’t for everyone.

Movement Therapy

Movement therapy utilizes exercise, yoga or other movement-based techniques in the treatment of mental illness. Exercise can alleviate depression and anxiety. Relaxation techniques are also used in movement therapy. Often, a movement therapy session consists of first doing an exercise and then talking it through with the therapist. Movement therapy can be done both in group and individual settings. I have experience with both and it’s been a help in channeling my irritability..

Music Therapy

Like movement therapy, music therapy is a form of non-verbal therapy for mental illness. I have never had music therapy, because it wasn’t offered at my old institution, and I get the impression that most people here use it to learn to play an instrument. For some though, merely listening to music can be healing and may be part of music therapy.

If you haven’t figured it out already, I need to make a confession: I am very easily stressed out. As I wrote on Thursday, I have been on or over the edge of a meltdown a couple of times lately. Since we are discussing what helps us relax on the spin cycle this week, I thought I’d list a couple of things.

1. Mindfulness and meditation. I do guided meditations every once in a while. Simply focusing on my breathing for a bit also helps. It is important not to make yourself do anything other than focus. If your attention drifts off, notice it and go back to focusing on the meditation or your breathing. You can also use a mantra.

2. Yoga. I discussed this before. Yoga can be hard when you do difficult poses, but remember yoga is for everyone. If you can’t do a certain pose exactly as experienced yogis do it, there is usually a way to adapt it to make it easier. That way, you are practising self-care, which is important in relaxation.

3. Essential oils. I own an AromaStream essential oil diffuser. It doesn’t use water or heat, so can be left on without supervision or even when you’re sleeping. There are many oils that are thought of as having relaxing properties. Examples are chamomile, lavender, bergamot, ylang ylang and jasmine. You can of course make diffuser blends.

4. Herbal teas. I have discussed these a few times. I find particularly chamomile, lavender and valerian root relaxing. St. John’s wort is thought of as having antidepressant properties.

5. Soothing music or sounds. I find that, while music that’s a little more upbeat helps cheer me up, if I truly need to relax, I benefit from nature sounds and soft music.

6. Blankets. I still need to buy myself a weighted blanket. However, lots of regular blankets also do the trick of helping me relax.

What helps yu relieve stress and relax? I’d love to read your responses in the comments or in a post of your own. Why not link it up with the spin cycle?

I have been reading a book about a woman with Asperger’s Syndrome and bipolar disorder. I have Asperger’s too, plus bordelrine personality disorder, which has some similarities to bipolar disorder. When I was sad because I recognized some symptoms this woman experienced, my husband said that the experiences I described are entirely normal.

This was a bit of a shock to me. Of course, I’m more than my mental illness. I am a woman, a wife, a blogger, a crafter, etc. too. What shocked me was that, in fact, struggling to an extent is normal. It isn’t like, as a mentally ill person, I am always struggling, and it isn’t like, as a currently mentally healthy person, you’re always blissfully happy.

I also read a post on happiness yesterday. In it, the author writes that, in spite of depression or other mental health struggles, you can choose to be happy. I commented (I think the comment is sitll in the mod queue) about a mental health support group on Facebook that is called something like “Mentally Ill People and Supporters Who Love life”. This, plus the realization about certain “symptoms” not being symptoms of a mental illness per se at all, made me realize that maybe happiness has little to do with mental illness.

Of course, depression clouds our minds and people in (hypo)manic states, like the woman in the book, often feel ecstatically happy. But still, you can choose to be optimistic, to be positive in spite of depression. I have in fact met and heard of and read about many people with major depression who call themselves optimists.

Like with any other outside circumstance, we can change our perception of a mental illness. This requires looking at our mental illness as something outside of ourselves, and that takes mindfulness.

It feels a little counterinuitive to see myself as separate from my mental illness, but maybe that is what it takes to choose happiness in spite of my mental health issues. I may have mood swings and feel depressed, suicidal even one moment, angry the next and then joyful, only to go back to depressed. This doesn’t define me, however. It is in fact possible to look beyond the immediate darkness of depression.

My classical culture teacher in high school once said that there is only one moment when you can be happy in your entire life, and that’s now. Having practised some mindfulness has indeed helped me embrace this statement and choose happiness now. If I choose happiness for a minute every sixty seconds, I’ll be happy no matter what happens.

It of course isn’t that simple. Some people more easily find the peace of mind to choose happeness for a minute every sixty seconds than others. This could be related to mental illness, such as major depression often taking over your entire mind. In this sense, the comment in the linked post that you cannot look to medication to make you happy, is only partly true. While antidepressants don’t make you happy indeed – they don’t do that, and it’s nothing to do with how badly yu want them to make you happy -, they do take away the darkest shadows of depression, so that depression doesn’t completely take over your mind anymore. That way, people with major depression will have the ability to actually practise mindfulness again, because, in fact, severe depression does make this next to impossible.

Medications are not for mild depression or anxiety. They firstly do not work that well and may have side effects. In addition, however, when mental illness doesn’t take over your mind, you still have the ability to look beyond it and enjoy your life in spite of it. Cognitive-behavioral psychotherapy works far better for mild depression or anxiety than meds, because it teaches you to choose your thoughts and actions and therby choose happiness.

I have to make a confession here. I have thought of asking my doctor to increase my antidepressant, even though I have only mild anxiety now. I look at those times when I am joyful and wish these occurred more oftne. Now I realize that I in fact have a choice. Anxiety at this point doesn’t take over my mind. If it did, I’d definitely look to medication. This is why I won’t go off my medication, which helped me climb out of the valleys of an unquiet, anxious mind. Medication is there to treat mental illness, and it is quite effective in my case. I won’t say I’m free from mental illness, but with regard to anxiety, for the most part it is mild, more like everyday worry than severe, debilitating madness. I can still manage it if I put enough effort into it. I shouldn’t want a blissful life thanks to my happy pills when I can choose that sense of bliss myself.

Food. I am addicted to it. Unfortunately, unlike other addictive substances, such as alcohol, cigarettes or drugs, food is something every living being needs. It isn’t like, when you become a part of Overeaters Anonymous or the like, you can abandon food like those in Alcoholics Anonymous or Narcotics Anonymous abandon their substance of abuse. I still fail to understand the twelve steps when applied to food.

Of course, I could abandon candy, chips, and other snacks. I bought a bag of candies twice this week and, each time, ate all of it within half an hour. In this sense, I’m not doing as well as I said on my blog that I was doing on Tuesday.

I tend to fall into the trap of believing that, since we need food, it doesn’t matter if I eat a bag of candies in half an hour. We don’t need those. Candies are addictive. Refined sugar wouldn’t have been approved by the FDA or similar organizations had it been first introduced today.

A few weeks ago, as I was panicking about some kind of poinsonous thing my husband was talking about, he said I ironically do not fear one of the worst poisons that we consume daily: refined sugar. I have to agree.

This afternoon, I knew that really I shouldn’t go to the store when I asked a nurse for a walk. And when I went to the store anyway, my first intention was to buy tomato soup only. Not terribly healthy, but there really isn’t anything healthy in this store. Fruit and veggies aren’t sold in my institution town’s only store, so well. I ended up buying a bag of my favorite candies too and genuinely promised myself I’d eat them mindfully and actually enjoy them. Not so.

Food. I really need to say the first step of the twelve steps of OA, which is that I’m powerless over it. I realize I truly am, but sometimes, I’m stuck in the trap of believing that you can’t be powerless over somethign that, well, everybody needs.

This post was inspired by one of Mari L. McCarthy’s journaling prompts in her free eBook Mari’s 143 Juicy Journaling Prompts. The prompt was to choose a four-letter word starting with “F”, and to journal about it.

This week, I’m participating in #theprompt once again. I am rather late, because I was quite busy with other things over the week. For example, on Wednesday, I had an intake interview at the country’s top notch autism center, which happens to be in my town. They are hopefully going to assess my needs and provide recommendations for when my husband and I will be living together.

The meeting was quite intense. However, I have been able to feel relatively calm lately thanks to practising mindfulness. Since this week’s prompt is “calm”, I am going to share some information about mindfulness and how it’s helping me.

Mindfulness is, as far as I understand, more or less a western, popular term for meditation. This is at least one type of mindfulness, the type that I practise when stressed. It involves trying to sit with my thoughts, feelings and bodily sensatiosn without judgment. You can try to focus on one aspect of your experience, such as your breathing. When distracted, you should not waste energy on fighting the distraction, but simply notice it and return to paying attention to your breathing.

Any activity can be done mindfully. For example, you might notice that you start eating and suddenly the entire plate or packet is empty and you didn’t realize you ate this much. Mindfulness teaches us to be aware of what we’re doing, feeling or thinking.

Mindfulness does not eliminate life’s pressures, but it helps us look at these pressures with more clarity and less judgment. For example, when you’re eating, you might think about all the calories you’re consuming rather than simply noticing the act of eating.

Mindfulness will also teach us to respond more adequately to experiences. This is achieved by creating a gap between the experience and our reaction to it, as in the example above. Mindfulness can help me actually enjoy food rather than binge on it.

In the example of the autism center meeting, I was constantly worried about what if I had to be re-assessed for autism all over again and what if my parents had to be involved and what if they were going to convince the professionals that nothing was wrong and what if… You get the idea. By being mindful, I would look more objectively at the meeting, which went quite well. However, I’d also sit with my present thoughts, feelings and bodily sensations without judgment. For example, I’d be conscious of my butt touching the chair or bed, my breathing, my current emotions, etc.

At this very moment, I am relatively calm. My fingertips touch the keyboard as I type this blog post. My bum and back touch the chiar as my toes touch the floor (my chair is too high for my entire feet to touch the floor). I could be thinkign about how the car broke down again yesterday. I could be worrying about all the stress of possibly buying a new one. Instead, I let these thoughts go by without judgment. I don’t fight them, but I don’t give them extra special attention either. It doesn’t mean the car isn’t broken or that we don’t have the pressure of buying a new one, but what use is there in worrying about this now that I’m writing?

Mindfulness can be useful in dealing with emotional stress, as in the examples above. It can also help in dealing with physical symptoms, such as pain. After all, we often tend to make the symptoms worse by worrying about them. If I feel an ache, the ache is usually not so all-encompassing that it in itself overpowers every other sensation. There are exceptions of course, but in most cases, the effects of pain get amplified by our thoughts about this pain. Again, what use is there in thinking about an ache? Will it lessen the ache? Quite likely not, and it will distress me. So I notice the ache but don’t give it more attention than it deserves. Of course, we do need to pay just enough attention to pain to take appropriate care, but particularly for chronic, largely untreatable and/or intractable pain, mindfulness can definitely help lessen its impact.

A fellow patient was screaming a lot today. It made me feel anxious, yet I was too sleepy to get out of bed until it really got on my nerves. Situations like these are hard to cope with, since the fear is not just “in my head”. Yet I get anxiety that is actually “in my head” a lot too. Some of it takes the form of worry, while other times, the anxiety takes the form of panic.

i was inspired today to write about things that help me cope with anxiety. Of course, different forms of anxiety require different coping strategies. For example, my PRN medication doesn’t help with worry, but it does help some with panic. Meds aside though, here are the activities I can think of now to cope with anxiety.

1. Breathing techniques. I learned some in movement therapy a few years ago, but they usually made me dissociate. Now that I’m generally more grounded, in that I don’t dissociate as often anymore, I’ve found breathing techniques can help me calm my mind. I need to make sure I actually concentrate on my breathing or I’ll go hyperventilate just when I’m trying to relax.

2. Mindfulness. I particularly like the “body scan”. With this, I go from toe to head, concentrating on each part of my body and how it is in relation to other parts of my body or my surroundings (like the chair I sit on). I learned this in yoga a few years back and, like breathing techniques, it could set off some dissociation when done the wrong way. The key seems to be not judging my mind when it wanders off, yet getting my focus back to my body as soon as I notice. Not judging my body is also important. I shouldn’t be overthinking that pain in my tummy or how my feet are wobbly, but just register my body and how it feels and then move on.

3. Reading. Last year, I rediscovered my love of juvenile fiction when I first started buying eBooks on Kobo. I make sure I always have some teen fiction in my Adobe Digital Editions. Teen fiction usually is just involved enough that it requires some concentration and just light enough that it doesn't get boring or triggering.

4. Music. when I’m worrying, I like to pick out music that has strong or funny lyrics, so that I will be listening to them. I have some great German country music on my computer (I understand a little German). Again, it is just hard enough that I will want to concentrate on the lyrics but not so hard that I give up.

When I’m more in a jittery state, it helps to pick music that has a soothing melody, or more often actually music that I can dance to. When I choose music to dance to, I don’t listen to the lyrics, so I might as well pick one of my Latino music albums that I bought when I was into world music.

5. Exercise. Dancing, as I said, can help, but so can a work-out. We have some exercise machines on the unit, so I can go on the stationary bike or elleptical trainer. I don’t usually last long on either as I’m in terrible shape, but even a ten-minute work-out can greatly reduce my anxiety.

6. Writing. Usually writing helps me not to lessen anxiety, but to express it in a safe way. I am still looking for the right journaling program (and no, Notepad still doesn’t feel right). Blogging (as opposed to freeform journaling) however can also greatly help me structure my thoughts.

In the Netherlands, borderline persoanlity disorder is sometimes also called emotion regulation disorder. There were in fact psychiatrists advocating for this name change in DSM-5, but it didn’t happen. Indeed, I myself notice that emotioon regulation problems are, besides having little sense of self, the most prominent symptom of my BPD. Tonight, I noticed how being told that I had to ask a fellow patient to help me with something minor rather than a staff member, set into motion a train of emotions and behaviors that I now realize, at least to some extent, was uncalled for.

Learning to regulate emotions does not mean stuffing them. Rather, it means observing and describing your emotions, decreasing your vulnerability to negative emotions and increasing positive emotions. Identifying what emotion you are feeling is usually the first step, and it can be especially hard. Many people, even those without mental illness, learn that certain emotions are not allowed, so they convert them into others. I for one often act angry when I’m sad or overwhelmed. However, all emotions have value.

Changing emotions requires first observing them without judgment, then letting go of them through for example mindfulness. Mindfulness allows you to experience the coming and going of emotions like a wave. In mindfulness, you shouldn’t try to block or suppress an emotion or try to keep it around. Rather, let emotion run its natural course.

This does not mean acting on emotions the moment they come up. We are not our emotions. Therefore, another step in emotion regulation is choosing whether to act upon your emotion. This seems impossible at first – at least, it does for me -, which is why mindfulness is important. When you have chosen to challenge an emotion, some therapies, like dialectical behavior therapy (DBT), explicitly teach acting opposite from the emotion. The most useful example of this I’ve heard is from a woman who suffered from bipolar disorder. When she was sliding into depression, she was encouraged to become active, while she was encouraged to take it slow when she was climbing towards mania. Other therapies, like rational emotive therapy, emphasize the fact that an emotion doesn’t come out of the blue, and encourage sufferers to challenge the thoughts that lead to their emotions. I believe that challenging cognitions may be best done when emotions are not overflowing you.